中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (11): 1027-1030.

• 论著 • 上一篇    下一篇

原发性肝细胞癌R0切除标准的探讨

吴力群，邱法波，张    顺，张    斌，郭卫东，曹景玉，王祖森，胡维昱，韩    冰，杨金镛，崔子介   

  1. 青岛大学医学院附属医院肝胆外科，山东青岛266003
  • 出版日期:2011-11-01 发布日期:2011-10-24

  • Online:2011-11-01 Published:2011-10-24

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摘要：

目的    探讨原发性肝细胞癌（HCC）肝切除术的根治标准，为提高HCC病人的外科疗效提供依据。方法 回顾性分析1998年1月至2007年12月青岛大学医学院附属医院肝胆外科406例原发性肝细胞癌肝切除术的临床资料，分析预后与临床、手术和病理因素的关系。 结果    以无瘤中位数生存月<6个月的因素归于非肿瘤完全切除（R0）因素，包括切缘病理阳性、术后血清甲胎蛋白（AFP）不降、姑息切除、肉眼可见血管癌栓、术后1个月经导管肝动脉化疗栓塞术（TACE）肿瘤血管染色并在1个月后肝脏CT扫描证实有碘油沉积（TACE阳性）、区域淋巴结转移和术后1个月肺转移。R0切除315例，1、2、5和10年的存活率为97%、86%、56%和35%，无瘤存活率84%、67%、42%和30%；R1和R2切除共91例，1、2和5年的存活率为48%、26%和10%，无瘤存活率为22%、11%和3%。 结论    HCC肝切除术非R0切除的因素除切缘病理阳性和姑息切除外，还应包括术后血清AFP水平不降、肉眼可见血管癌栓、术后TACE阳性、区域淋巴结转移和术后1个月肺转移。

关键词: 肝细胞癌, R0切除, 复发, 评估

Abstract:

Estimate of the criterion for R0 resection in primary hepatocellular carcinoma        WU Li-qun, QIU Fa-bo, ZHANG Shun, et al. Department of Hepatobiliary Surgery, Affiliated Hospital of Medical College Qingdao University, Qingdao 266003, China
Corresponding author：WU Li-qun, E-mail：wulq5810@126.com
Abstract    Objective    To estimate the criterion for R0 resection of primary hepatocellular carcinoma (HCC). Methods The clinical data of 406 cases of primary HCC underwent hepatectomy from January 1998 to December 2007 in Department of Hepatobiliary Surgery, Affiliated Hospital of Medical College Qingdao University were analyzed retrospectively. The relationships between the clinical, operative and pathologic factors were analyzed. Results    The factors which the median recurrence-free survival months were smaller than 6 months were considered non-R0 resection, included the vascular invasion, palliation resection, cutting edge pathologic residual tumor, lymph notes metastasis, serum AFP level continuing higher after operation or / and positive TACE (tumor dyeing on TACE within 1 month and a deposit of lipiodol on CT scan). There were 315 cases of R0 resection. Their recurrence-free survival was 84%, 67%, 42% and 30% (1, 2, 5 and 10 year) and overall survival was 97%, 86%, 56% and 35%. In 91 cases of non-R0 resection, the recurrence-free survival was 22%, 11% and 3% (1, 2 and 5 year) and overall survival was 48%, 26% and 10%. Conclusion    The R0 criterion for HCC resection contains the vascular invasion, palliation resection, cutting edge pathologic residual tumor, lymph notes metastasis, serum AFP level continuing higher after resection or / and tumor dyeing on TACE within 1 month.

Key words: hepatocellular carcinoma, R0 resection, recurrence, evaluation